Thursday, February 03, 2011

Audit: UTMB overcharged state while claiming massive deficit

The State Auditor's Office will be releasing an analysis today, reports the Austin Statesman ("UTMB prisoner health costs, raises scrutinized," Feb. 3), critical of UTMB's provision of healthcare at state prison facilities, accusing the agency of overcharging and giving large, unwarranted raises to dozens of employees. (UPDATE: Now online here.) Reports Mike Ward:
Texas taxpayers are spending more on treating convicted criminals at a Galveston hospital than they are on law-abiding citizens in other parts of the state, a critical audit of spiraling prison health care costs reveals.

Expected to be made public sometime today , the report by the State Auditor's Office also alleges that the University of Texas Medical Branch at Galveston charged the state's prison health care program for more than $16.2 million in costs not directly related to prisoner care, spent more than $6.6 million in two years for items that were not allowed under the prison contract and handed out $14.1 million in pay increases over three years while reporting that the program had a $95.1 million deficit.

In one case, the audit discloses, 40 employees of the prison medical division of UTMB received bonuses last November for which they were not supposed to be eligible — one receiving a payout of $125,460 — at a time when state agencies had been ordered to cut spending by 15 percent to staunch a predicted $27 billion budget shortfall.

A copy of the audit was obtained by the American-Statesman as it was distributed to select legislative leaders.

According to the audit, UTMB's prison health care division charges more for reimbursement for physician services, inpatient hospital services and outpatient services than it does for Medicare, Medicaid and at least one major private insurer's reimbursements.

The reimbursement amount for physician billing is, "on average, 135 percent of the Medicare reimbursement amount," the audit states.
State Sen. Steve Ogden had the money quote of the story:
"We did not know until the audit that UMTB was being reimbursed at the rate that it is, ... that we are paying more to treat felons than we are to treat law-abiding citizens," said Senate Finance Committee Chairman Steve Ogden, R-Bryan. "As I said earlier, ... we're going to uncover every rock, and this is one of them."
That may be a little unfair, though it's a great soundbite. I can think of reasons why it might cost more to deliver healthcare in a secure institutional setting than to free-world clients. OTOH, UTMB's reliance on telemedicine supposedly should have reduced costs, or so we've been told for years. Setting medical rates can be a tricky business, though I agree it's difficult to understand how rates for prison care could be higher than Medicare, much less private insurance plans. (UPDATE: From the audit overview, "UTMB develops reimbursement amounts for UTMB-CMC Division services internally without independent review and approval from the Correctional Managed Health Care Committee." If UTMB sets its own rates without oversight and takes lower rates from other clients, that is indeed problematic.)

Perhaps even more significant than the dispute over reimbursement rates, "The report also notes that UTMB might be charging 'a disproportionate amount of UTMB's indirect costs' to the prison health care program, including part of the salary of a senior vice president. It suggests that as much as $16.2 million in costs charged to prison health care might not be going toward providing care for offenders."

There's also coverage from the Dallas News, but it's behind their new paywall. I'll have more to say on the subject after the audit is publicly released, but this news casts an entirely different light on UTMB's complaints than they've been shorted $61 million by the prison system last biennium.

Ward says UTMB on Tuesday requested to cancel their contract to provide healthcare to the prison system, citing red ink in the budget, but one suspects legislators will continue this shotgun marriage for the foreseeable future, if only because they have few other immediate options.

MORE: Here's a response from UTMB published in the Galveston Daily News.


Anonymous said...

"In one case, the audit discloses, 40 employees of the prison medical division of UTMB received bonuses last November for which they were not supposed to be eligible — one receiving a payout of $125,460 — at a time when state agencies had been ordered to cut spending by 15 percent to staunch a predicted $27 billion budget shortfall."

It's the culture in government and private today; federal, state, county, city and Texas schools.

There should be serious consequences for agency administrators if they were ordered to cut but gave bonuses instead.

Why do politicians refuse to go on the record and admit the problem? Why do we refuse as individuals to admit our own personal contributions to the economic problems of our state and country by spending what we don't have?

Anonymous said...

Somewhere, William Wayne Justice is smiling!

Anonymous said...

"There should be serious consequences for agency administrators if they were ordered to cut but gave bonuses instead."

Ben Raimer, Steve McCraw and DPS brass, Rissie Owens, Brad Livingston, the TYC raises - all these agency heads got raises last year while pay for TDCJ COs is actually getting cut!!! Raimer getting $125,000 is insane, and Rissie getting 10% when theyre about to fire POs is a slap in the face.

Not a lot of money compared to the whole budget, but symbolically it speaks volumes.

Anonymous said...

@ 8:43 "Not a lot of money compared to the whole budget, but symbolically it speaks volumes."

Symbolically in the arrogance of it all and "middle finger" attitude.

gravyrug said...

This is even more disgusting when you consider what we're getting for the money. The healthcare prisoners actually get is certainly not anything worth paying extra for. It varies fairly wildly between individual facilities, but overall, it's not very good.

DeathBreath said...

Maison Rouge & UTMB sit on the same street. Yes, although Jean Lafitte is long gone, the UTMB carries on the tradition of stockpiling booty. Both were involved in the slave trade. I suppose I should be fair & refer to UTMB workers as indentured servants, not slaves.

Will anyone in the Texas "laughislature" ever peel back the layers of this stinky onion? I seriously doubt it.

If you did not know it, UTMB was under investigation by the FBI for billing fraud in the E.R.

Jean LaFitte was far more credible than this hospital of misfits. At least he did not sell human body parts.

UTMB knows one thing, "self-preservation." They have a pattern of hiring the most vile of serpents to manage the masses.

But, I will let the journalists uncover and report all of their misadventures. I know it will make for an interesting read. If published, it should be printed with a warning, "for bathroom use only." Otherwise, people might soil themselves in public.

JTP said...

I was looking for a sound bite from Whitmire similar to what he graced the TYC people with, "What the Hell were they thinking?" Clearly, this is business as usual and will not be seriously reviewed as part of the budget cuts because all the politicians pretty much feel they can say one thing and do another without the voters giving a hoot. Teachers, CO's, Health and Human Service workers. troopers, and taxpayers at the county and local government level will all loose by loss of jobs and higher taxes. The Federal and State government politicians never seriously hurt members in their own club. The media reports these things, the politicians provide some sound bites of outrage and then just wait for the "electorate" to forget the issue. Over and over. Eventually, you get your own version of Cairo. Even then you just exchange one corrupt political ragime for another. Does anybody out there believe that the "Tea Party" legislators have a different heart for these issues. Let's hope so. Let us Pray. JTP

Prison Doc said...

One can be sure that the tale has not all been told, nor the final denouement revealed. I suspect, as Grits concluded, the shotgun marriage will continue.

One comment I'd add is regarding the canard of "billing 135% of Medicare rates". This may be true, but it is commonly acknowledged that Medicare rates to not cover expenses, much less allow for any profit. The idea of "I only lose $10 per sale but I'll make it up on volume" makes no sense.

As Will Rogers liked to say,"All I know is what I read in the papers."

Anonymous said...

Iwould love to see what the state is charged for the lack of medical care at the Gatesvile units. The medical care staff downs there gives torture a whole new meaning!

Anonymous said...

Gatesville is where they carry out inhuman medical experiments. That staff should be charged with crimes against humanity.

Anonymous said...

The Gatesville Gulag
The medical services are inept, inhumane and a travesty to the good tax payers of Texas. How can they charge some a $5.00 co-payment when we the family is told 80K a year is being spent on prisoners? If for god’s sake you have to be shipped to hospital Galveston I will pray for you. No woman should be hogged tied and put on a bus for this travel and returned the next day after surgery shackled. This is inhumane to say the least. There have been instances where pregnant women have died down the in Gatesville with medical problems that easily could have been treated if there was any human compassion at all there. I was told a woman was written up for make too much noise one night right before she died in the dorms. The Tele medicine that UTMB charges the taxpayers is fraud. Tele medicine is supposed to provide onsite physician medical care without moving a prisoner across the state. That was the services that UTMB sold the state legislators as a money saving initiative to gain this lucrative contract. Most women will refuse medical treatment depending on who is giving this treatment. Some will forego OB/GYN services because the initial Pap smear is conducted by a Physician Assistance and not a doctor. I would urged anyone to avoid this examination completely now. One woman told me she did not believe her experience was unique. I have talked to several women, who have complained about the way their exams were done, who did them, just that issue in general. Women have talked about leaving the table bleeding because they have been treated so roughly: women who had abnormal results from Pap smears and other examinations aren’t treated properly. Women in prisons have a high risk for cervical cancer because they are exposed to multiple risk factors such as a diet low in fresh fruits and vegetables so my question is again where this so-called 80K a year being spent is. Also some women have said tests are provided in small, unclean rooms, without privacy, and that staff often inflicts pain while administering the tests. One woman stated “[physician] was cramming the speculum in like a Roto Rooter”. Some reported feeling sexually abused or violated during their Pap-smear examination. Many connect this feeling to previous histories of sexual or physical abuse. I have been told they would rather have a female care provider, who they believe would be more compassionate and understanding than male personal. Very few of the medical personal offer any explanations of the examinations, the results, or follow up care, including prescription drugs. When asked questions often times the medical personal are not receptive. As a result of these barriers, many people locked up avoid or refuse subsequent treatment by prison medical providers. One woman said terrified by her experience with a physician, said, “I would refuse another Pap smear by him. I just couldn’t do it, couldn’t go through it again. Many people in women’s prisons are aware of the potential health risks of refusing medical appointments but believe that this risk is outweighed by the value of avoiding violation by medical personal and maintaining their integrity, rights to privacy, and personal autonomy. In maintaining this system, TDCJ and UTMB blatantly violates the patients’ rights to family. Behind the prison walls, women are not allowed to show emotions, to simply put their arm around someone crying by lost of a family member. Their anger, pain and other feelings must be kept under tight control. To speak out or show their true feelings will lead to a guard writing up a case and then a kangaroo court where the house rarely loses. So exempt for tears they have nothing else or no one to turn to.

Anonymous said...

If you are a CONVICTED offender, YOU should lose your right to privacy. In this day and age of reductions in funding, the fact that Pap smears and other preventative medical services that a large portion of LAW ABIDING TAX PAYING citizens can't afford are available within the prison system for free is a disgrace. Privacy in prison - whatever!

Anonymous said...

I wondered if your daughter wanted to talk to you or ask your opinion would you feel that way? Every county Health Department in the state of Texas offers these services for free to everyone. So you think sexually abuses and assaults diguised as a medical exam is fine also? What if it was one of your family members? Watch out what ever you are smoking may entitle you too a free TDCJ medical exam.

Anonymous said...

I guess you think it is alright to charge the tax payers for sevices not render. You must work for either TDCJ or UTMB or wait a minute are you a state Senator or Representative?

Anonymous said...

No this is a lobbyist paying bribes to secure these contracts for UTMB.

Anonymous said...

I believe this is a TDCJ employee trying to cover up more crimes

Anonymous said...

I wonder if this clown thinks it is okay to post on the internet some ones picture or their medical condition on the internet too. You would be surprise what the employees of TDCJ and UTMB post on the internet. But hey they are not humnan beings they are low down offenders. Right? Maybe Karma will place your love one in one of those female prisons one day to be sexually assaulted also.

Anonymous said...

"If you are a CONVICTED offender, YOU should lose your right to privacy. In this day and age of reductions in funding, the fact that Pap smears and other preventative medical services that a large portion of LAW ABIDING TAX PAYING citizens can't afford are available within the prison system for free is a disgrace. Privacy in prison - whatever!"


Nice hearing from you Raimer! I would've thought you'd be too busy spending your $125,460 bonus to be posting.

All the laid off UTMB staff salute you - middle finger extended.

Anonymous said...

I knew this was an UTMB big shot defended the lack of medical care!!!

Anonymous said...

Some folks from UTMB need to be in jail, rather than ripping off inmates and the public. Fire em' and cut the top administrators by 2/3's.

Anonymous said...

UTMB has not even mentioned their federal contract for correctional care, which showed profit this past year.

UTMB gave raises and bonuses to
the employees in Galveston.. but, the correctional side got lay offs, no raises, and definitely no bonuses.. some of the employees who were laid off had been with UTMB for more than 10 years.. sure glad Raimer got $125,460 bonus, while his former employees lost their health care, their benefits, and their jobs...

For those who have used this as an opportunity to criticize UTMB employees who work in the prisons.. grouping all of them together, saying they are horrible etc... well, that is just like saying that all inmates should be grouped together, that all of them are horrible...

Anonymous said...

I almost threw up reading that UTMB Correctional Mgmt. received anything other than their paycheck. Many last year lost their jobs in UTMB CMC, these wern't high up MGMT. but long term, dedicated on the ground and in the trench employees that take caring for people to heart. Please do not assume that all apples in Correctional Medicine are bad, but it's time that the those smellin up the place, out for their own ego and benifit and those only interested in big $ be booted out on their ...time to return the reins to the people in the trenches that show respect for the patient and the mission of going above and beyond for a human being. I know there are some of these folks left that they haven't run off yet.

NurseyPooh said...

I'm not sure where your info comes from on the mistreatment of female offenders concerning their pap's etc. ??????
Who told you this?
I'm a nurse with UTMB and assist with paps, breast exams etc. it is done with the door closed, a gown, explanation, education, and with compassion just like at most private clinics. I'm sure there are some units which don't have the best employees but a Pa or NP is more than qualified to do these paps.